What Happens If You Forget to Add Baby to Insurance?

Adding a newborn baby to health insurance is an important task for new parents. Most insurance policies require you to enroll your baby within 30 days of birth to get them covered. But it’s easy to forget this crucial step during the haze and busyness of having a newborn.

So what happens if you miss the enrollment deadline? Here’s a detailed look at the implications, options, and steps to take if you realize you forgot to add your baby to your health insurance.

Overview: Consequences of Missing Enrollment Deadline

If you miss the 30-day enrollment window, your request to add coverage will be denied by the insurance company. This will happen even if adding the baby wouldn’t increase your premium.

Some key consequences if baby isn’t enrolled in time:

• Baby will be uninsured: The baby will not have health insurance coverage until the next open enrollment period or qualifying life event.

• Limited coverage in first month: Some plans cover newborns under the mother’s policy for the first 30 days. But coverage will end after that grace period without separate enrollment.

• You’ll pay full cost of care: Doctor visits, vaccines, medications etc. will need to be paid fully out-of-pocket if baby is uninsured. These expenses can really add up.

• Pre-existing conditions may not be covered later: If baby has any health issues before being insured, they could be declared pre-existing conditions when you eventually enroll them. This means ongoing care for these conditions may not be covered.

• No government assistance programs: An uninsured newborn doesn’t qualify for Medicaid or CHIP coverage outside of open enrollment.

• Tax penalties possible: Under the Affordable Care Act, you may have to pay a tax penalty if baby is uninsured for 3+ consecutive months.

Clearly, missing the newborn enrollment deadline has serious financial and healthcare coverage implications. So it’s crucial to remedy the situation as soon as possible.

Reasons Newborn Enrollment is Missed

How does something so important slip through the cracks? Here are some common reasons parents unintentionally fail to add their newborn to insurance:

• Exhaustion and overwhelm: The massive learning curve of new parenthood can mean crucial tasks fall by the wayside.

• Lack of sleep: Endless middle-of-the-night feedings leave parents unfocused and forgetful.

• Assumption of automatic coverage: Some incorrectly assume newborns are automatically covered from birth.

• Confusion about deadlines: Multiple application windows can lead to confusion on exactly when newborn must be added.

• Difficulty gathering documents: Delay in obtaining baby’s Social Security and birth certificate documents needed for enrollment.

• Changes at work: For employer insurance, parents on leave often miss notifications of enrollment deadlines.

• Processing delays: Mail delays and administrative lag time means coverage doesn’t begin as expected.

• Planning to breastfeed: Since baby won’t need insurance right away some parents delay, planning to enroll when breastfeeding ends.

With so much swirling around post-birth, it’s easy for even the most organized parent to overlook this key administration task. But catching the mistake soon limits long-term consequences.

Immediate Steps If You Missed the Deadline

If you identify that you’ve missed enrolling your baby within 30 days, take the following steps right away:

• Call your insurer: Contact your health insurance company and explain the situation. Plead your case for an exception to add coverage now. Emphasize extenuating circumstances like hectic newborn phase.

• Ask about grievance process: If the insurer won’t make an exception, request details on filing an official grievance or appeal. This is a structured process to formally request reconsideration.

• Get paperwork ready: To speed up enrollment if an appeal succeeds, prep needed documents like baby’s birth certificate and Social Security number.

• Pay for COBRA: If on an employer plan, you may be able to pay for COBRA retroactive coverage during the gap. This can be very expensive but ensures continuity.

• Check on spouse’s plan: If you’re on one employer plan, check if baby can still be added to the other parent’s insurance (if they have a different plan).

• Look into CHIP: Though not a guarantee, you may be able to enroll baby in the Children’s Health Insurance Program until next open enrollment based on income eligibility.

• Ask about retroactive Medicaid: In some states, Medicaid can be backdated to baby’s birth month if approved. Unlike CHIP, there is no income threshold.

Moving quickly gives you the best shot at successfully appealing a late newborn enrollment denial.

Tips to Get Late Enrollment Approved

Here are some tips to boost your chances of getting baby added to insurance if you missed the initial deadline:

• Highlight extenuating circumstances: Document chaos and sleep deprivation of having a newborn that led to oversight.

• Note immediate request: Emphasize you requested enrollment as soon as you realized the mistake, not months later.

• Offer late enrollment fee: Ask if paying a penalty fee would allow retroactive coverage.

• Get doctor notes: Provide notes from pediatrician emphasizing need for insurance coverage.

• Check other plans: If ineligible for special enrollment on current plan, check rules on switching to a different insurer.

• Alignment with enrollment goals: Point out that covering your new baby fits with the insurer’s overall membership aims.

• File complaint: If appeal denied, file a complaint with your state’s Department of Insurance regarding improper denial.

A well-prepared appeal highlighting the urgent need for newborn coverage can convince insurers to make an exception and reverse the late enrollment denial.

What Newborn Care Could I Have to Pay For?

If efforts to obtain retroactive insurance fail, you’ll likely have to pay out-of-pocket for any newborn medical expenses. Here are some common newborn healthcare services that would no longer be covered:

• Hospital delivery and postnatal care
• Routine pediatrician visits for check-ups
• Newborn screenings for health conditions
• Vaccinations like hepatitis B and Vitamin K
• Circumcision
• Sick visits for issues like fever, vomiting, diarrhea
• Medications and prescription ointments

Beyond direct medical costs, you may have to pay full price for:

• Lactation consultant
• Hearing tests
• Vision screening
• Blood tests

And if baby has underlying health issues, expenses are dramatically higher. Neonatal intensive care, surgery, therapy services, and specialty pediatric care can all quickly add up.

Having to cover these uninsured newborn costs entirely out-of-pocket because of a paperwork oversight can be financially devastating for families. That’s why fixing the insurance lapse promptly is so vital.

Will My Oversight Affect Future Enrollments?

If you miss initially enrolling your newborn but then add them later, will it impact future newborn enrollments?

In most cases, there are no ongoing repercussions of having previously forgotten enrollment. Consider:

• Each child is separate: Insurers treat each newborn as a distinct case. A past oversight won’t necessarily impact enrollment of your next baby.

• Review process improvements: You can fix gaps in your enrollment process to prevent repeats of the same mistake.

• Earlier document prep: Advance gathering of birth records helps meet tighter deadlines for future newborns.

• New plan options: You may choose different insurance with more flexible newborn enrollment rules.

• Life changes: A new job or different insurer resets enrollment timelines.

While an administrative headache in the present, your past failure to promptly enroll a baby is unlikely to cause issues adding your next newborn to insurance. Each child triggers their own enrollment window.

Tips to Avoid Missing Enrollment Going Forward

To avoid ever again scrambling because you forgot to add your baby to insurance, keep these tips in mind:

• Note enrollment deadlines in advance: Record key dates like 30-day newborn deadline before the due date.

• Set calendar reminders: Schedule alerts on your phone to complete enrollment forms.

• Prep documents early: Have baby’s Social Security and birth certificate ready to go in advance.

• Automate forms: Some insurers let you pre-fill newborn paperwork if you know baby’s due date.

• Coordinate with hospital: Ask about having birth records expedited to assist quick enrollment.

• Involve partner: Ensure your spouse knows about deadlines and can act as a backup.

• Confirm policy details: Verify with insurer in writing the exact newborn enrollment requirements.

• Use insurance agents: They can monitor deadlines on your behalf and walk through enrollment details.

• Discuss at work: Alert your HR department you’ll need to enroll baby and may need guidance.

• Have a post-birth checklist: Include adding newborn to insurance on a master checklist to ensure it’s not overlooked.

Making newborn insurance